Apixaban Dose in Patients With Atrial Fibrillation and Acute Coronary Syndrome and/or Undergoing Percutaneous Coronary Intervention: Insights From AUGUSTUS
Authors' conclusion
Of the ∼10% of patients in AUGUSTUS who received reduced dose apixaban, less than one-half met the dose-reduction criteria. In patients with AF and recent ACS or PCI, appropriately reduced dose apixaban was associated with a lower risk of bleeding and similar rates of ischemic outcomes compared with VKA, similar results were found with standard dose apixaban. (A Study of Apixaban in Patients With Atrial Fibrillation, Not Caused by a Heart Valve Problem, Who Are at Risk for Thrombosis [Blood Clots] Due to Having Had a Recent Coronary Event, Such as a Heart Attack or a Procedure to Open the Vessels of the Heart; NCT02415400).
Study context
- Population
- Patients with atrial fibrillation (AF) and/or recent ACS or percutaneous coronary intervention (PCI) on a P2Y12 inhibitorrandomized in AUGUSTUS, 2,290 patients assigned apixaban
- Participants
- 4,614 patients
- Comparison
- Appropriately reduced, inappropriately reduced, and standard dose apixaban vs matched patients receiving vitamin K antagonist (VKA)
- Appropriately reduced dose apixabann = 98
Methodological detailsopen-label apixaban or vitamin K antagonist (VKA), blinded aspirin or placebo
- Open-label apixaban or vitamin K antagonist (VKA)
- Blinded aspirin or placebo
Primary result
As reported in the abstract
Further findings
| Outcome | Appropriately reduced dose apixaban | Inappropriately reduced dose apixaban | Standard dose apixaban |
|---|---|---|---|
| Death or ischemic events | 12.2% | 12.3% | 5.7% |
Clinical outcomes, 3 apixaban dose groups vs matched patients receiving VKA
- Patients receiving apixaban had more favorable outcomes than those receiving VKA
- Without significant interaction (P > 0.20 across all 3 groups and all outcomes)
Apixaban dose received
- Of 2,290 patients assigned apixaban, received reduced dose apixaban
- 229 (10%)
- Of those 229 receiving reduced dose, met dose-reduction criteria
- 98 (43%)
Original publication
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